Development and evaluation of a home-based exercise intervention for frail older people

Tuesday, 24 January 2012 00:00
Clegg, A.P
eTheses

Frailty is common and is associated with important adverse health outcomes. There is evidence that exercise may influence the biological mechanisms of frailty and improve adverse outcomes.

This thesis describes the development and evaluation of the Home-Based Older People's Exercise (HOPE) programme - a home-based exercise intervention for frail older people.

Methods: The MRC framework for the development and evaluation of complex interventions was used to develop and evaluate the HOPE programme. The development process synthesised information from four key domains: a systematic literature review; a process of intervention modelling work incorporating multiperspective focus group meetings; a review of behaviour change techniques and a review of international exercise guidelines. Following development, the HOPE programme was evaluated in a pilot randomised controlled trial. The primary outcome was mobility, measured using the Timed-Up-and-Go test (TUGT). Secondary outcomes included activities of daily living (ADL), quality of life and depression.

Results: The systematic review identified preliminary evidence that exercise may improve outcomes for frail older people. A grounded theory analysis of the multiperspective focus group meetings identified the important challenges faced by frail older people, along with motivators and barriers to exercise. The results were synthesised into the HOPE programme, which is a 12 week home-based exercise intervention. 60 participants were recruited to the HOPE trial. Mean age was 78 years. Baseline characteristics were similar in the two groups. There was a nonsignificant trend towards an improved outcome in the intervention group (mean adjusted between group difference in TUGT 16.7s, 95% CI -33.3, 66.6s). There were no differences in any of the secondary outcomes.

Discussion: The HOPE trial has provided valuable process, resource, management and scientific data to guide the development of a future definitive RCT and has provided important information to help inform future research involving frail older people.

Editor's comments - [ The above is the abstract from an original PhD thesis; the final publication in the study for the author in pursuit of a doctorate; such works result in the author being awarded a PhD and the title of Dr. by an appropriately accedited University. PhD's are the culmination of a number of years work by the author supervised by two (normally PhD or MPhil qualified) academics and, with the addition of a further appropriately qualified academic (not normally from the same University) as part ofa viva-voce examination team. Successful research work at PhD level is designed to add to the body of knowledge in the study area at some level.

A PhD thesis often forms the foundation for journal articles for the author and leads to further enquiry in the form of what is called post-doctoral research. These works are characterised by comprehensive literature reviews, sometimes traditional yet multiple (and often mixed) methods, interesting if not ground breaking discussions and always directional signs toward further research; they provide for undergraduates not only a model for the possibilities for further study but a gift in terms of references in any given subject areas.

To reference an eThesis the convention in the text is the same as a book; author (date), in the reference list there is some debate; theses are more often than not, unpublished works, yet when listed on databases at Universities or elsewhere it could be argued that they are published.